ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1914

 

Adhesive Capsulitis: Understanding Risk Factors for Operative Intervention

Ryan S. Selley, MD, Chicago, IL UNITED STATES
Richard W. Nicolay, MD, Chicago, IL UNITED STATES
Vehniah K. Tjong, MD, FRCSC, Chicago, IL UNITED STATES
Cort D. Lawton, MD, Chicago, IL UNITED STATES
Michael Terry, MD, Chicago, IL UNITED STATES
Vehniah K. Tjong, MD, FRCSC, Chicago, IL UNITED STATES

Northwestern Memorial Hospital, Chicago, IL, UNITED STATES

FDA Status Not Applicable

Summary

The aim of this study was to determine which pre-operative risk factors are present in patients with adhesive capsulitis that ultimately require shoulder arthroscopy.

Abstract

Objectives:
Adhesive capsulitis is a poorly understood disease that results in pain and loss of motion in the shoulder joint. The majority of patients are successfully treated conservatively with anti-inflammatory medications, physical therapy and intra-articular injections. However, some recalcitrant cases require arthroscopic surgical release. The aim of this study was to determine which pre-operative risk factors are present in patients with adhesive capsulitis that ultimately require shoulder arthroscopy.

Methods

The National Surgical Quality Improvement Program (NSQIP) was queried from 2006-2016 for all patients undergoing shoulder arthroscopy (n=63,933). All patients with the diagnosis of adhesive capsulitis who required shoulder arthroscopy (n=1641) were analyzed for risk factors compared to the rest of the shoulder arthroscopy population. All patients with an infectious diagnosis were excluded. Student t-test was used to compare groups, univariate and multivariate analyses were performed to identify risk factors, p-values <.00625 were considered significant.

Results

Patients undergoing shoulder arthroscopy for adhesive capsulitis were an average age of 52.3+/-14.6 years, a much larger percentage of the cohort were female, and diabetic compared with the overall shoulder arthroscopy population (58.0% vs 38.8%, p<0.0001) and (14.9% vs 4.6%, p<0.0001). Multivariate analysis demonstrated female sex [OR 2.19 (95% CI: 1.98-2.42); p<0.0001] and diabetes [OR 3.914 (95% CI: 2.83-4.53), p<0.0001] are independent risk factors for undergoing shoulder arthroscopy for adhesive capsulitis. Contrarily, BMI >30 demonstrated a protective effect for patients undergoing shoulder arthroscopy for adhesive capsulitis [OR 0.71 (95% CI: 0.64-0.78), p<0.0001]. In a subset analysis, post-menopausal females (females with age >45) undergoing shoulder arthroscopy, had a significantly higher risk of having a diagnosis of adhesive capsulitis [OR 2.08 (95% CI: 1.89-2.3); p<0.0001].

Conclusions

Female sex and diabetes are significant risk factors for undergoing shoulder arthroscopy for the diagnosis of adhesive capsulitis while obesity (BMI>30) appears to confer a modest protective effect. Understanding the risk factors for adhesive capsulitis that requires shoulder arthroscopy will help orthopedic surgeons more appropriately counsel patients regarding their risk of failing non-operative management.